Individual
MS. SUSAN M WIGHTMAN-HENTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
34TH STREET AND CIVIC CENTER BOULEVARD, PHILADELPHIA, PA 19104
(215) 590-1719
(215) 590-1771
Mailing address
34TH STREET AND CIVIC CENTER BOULEVARD, PHILADELPHIA, PA 19104
(215) 590-1719
(215) 590-1771
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
RN280126L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
PA
Enumeration date
12/11/2006
Last updated
04/10/2012
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